Job Description

JOB DESCRIPTION Job Summary

Provides support for member engagement and member retention activities. Represents members in areas involving member impact and engagement including: appeals and grievances and member issue research and resolution. Provides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions and complaints. Resolves member inquiries and complaints fairly and effectively. Provides product and service information to members, and identifies opportunities to maintain and increase member relationships. Recommends and implements programs to support member needs, and develops/maintains member materials.

Essential Job Duties

• Provides direct telephonic assistance to members and/or member family members seeking to resolve issues or complaints; seeks to engage and retain new and existing members.

• Ensures enrollee's rights are upheld and helps enrollees understand their rights and benefits in working through the system.

• Assists members in the complaint and appeal process; determines the nature of the member's needs or problem; informs members of their rights in the complaints and appeals process; and advises/refers as appropriate for investigation and resolution.

• Serves as an advocate in collaboration with providers, regulatory agencies, outside agencies, colleagues and other functional departments as appropriate.

• Educates members on covered services available to them, including preventive services.

• Provides support to enrollees and providers in provision of plan benefits.

• Educates members on covered services available, including preventive services.

• Provides information, guidance and assistance over the phone or in person to members with disabilities who call for help related to plan participation; analyzes internal system functions that affect enrollee access to medical care and quality of care.

• Collaborates with the care management team to support resolution of member issues/concerns; ensures that trends are identified and solutions outlined.

• Conducts focus groups in service delivery area as needed to ensure member needs are being addressed.

• Supports ongoing member advocacy training and disseminates member advocacy educational materials to internal staff, providers, and subcontractors.

• Conducts in person meetings with members and/or family members as appropriate.

• Accurately and timely documents member contacts/cases in appropriate database.

Required Qualifications

• At least 2 years of experience in member services, member outreach, community engagement, consumer advocacy, and/or customer service —preferably in a managed care or health care setting, or equivalent combination of relevant education and experience.

• Effective interpersonal skills, with a customer-first mindset.

• Experience conducting intake, interviews, and/or research of consumer or provider issues.

• Basic understanding of managed health care systems and behavioral health issues.

• Ability to work both independently and as part of a team in a fast-paced environment.

• Ability to assess needs and make thoughtful decisions to support members.

• Time-management and organizational skills.

• Ability to work cross-functionally within a highly matrixed organization.

• Effective verbal and written communication skills, and professional telephone etiquette skills.

• Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

• Call center experience.
• Managed care experience.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V